Impact of Neighborhood Socioeconomic Disadvantage on Staffing Hours in US Nursing Homes

Abstract Severe socioeconomic disadvantage in neighborhoods where nursing homes (NH) are located may be an important contributor to disparities in resident quality of care. Disadvantaged neighborhoods may have undesirable attributes (e.g., poor public transit) that make it challenging to recruit and retain qualified staff. Lower NH staffing could subsequently leave residents vulnerable to adverse events. Thus, the purpose of this study was to evaluate whether NHs located in socioeconomically disadvantaged neighborhoods had lower healthcare provider staffing levels. We linked publicly available NH data geocoded at the Census block-group level with the Area Deprivation Index, a measure of neighborhood socioeconomic factors including poverty, employment, and housing quality (percentiles: 1-100). Consistent with prior literature on threshold effects of neighborhood poverty on outcomes, we characterized NHs as being located in a disadvantaged neighborhood if the census-block group ADI score was ≥85/100. We used generalized estimating equations clustered at the county level with fixed effects for state and rural location to evaluate relationships between ADI score and staffing. NHs located in socioeconomically disadvantaged neighborhoods had 12.1% lower levels of staffing for registered nurses (mean: 5.8 fewer hours/100 resident-days, 95% CI: 4.4-7.1 hours), 1.2% lower for certified nursing assistants (2.9 fewer hours/100 resident days; 95% CI 0.6-5.1 hours), 20% lower for physical therapists (1.4 fewer hours/100 resident-days; 95% CI 1.1-1.8 hours), and 19% lower for occupational therapists (1.3 fewer hours/100 resident-days; 95% CI 1.0-1.6 hours). These findings highlight disparities that could be targeted with policy interventions focused on recruiting and retaining staff in socioeconomically disadvantaged neighborhoods.


IMPACT OF COVID-19 PANDEMIC ON MENTAL HEALTH, SOCIAL CONNECTEDNESS AND COGNI-TIVE PERFORMANCE OF OLDER ADULTS
Juliana Souza-Talarico, 1 Fernanda Silva, 2 Maria Clara Jesus, 3 Breno JAP Barbosa, 4 Ricardo Nitrini, 5 and Sonia MD Brucki, 4 , 1. The University of Iowa,Iowa City,Iowa,United States,2. School of Nursing,University of Sao Paulo,Sao Paulo,Sao Paulo,Brazil,3. School of Nursing,Universit of Sao Paulo,Sao Paulo,Sao Paulo,Brazil,4. Faculty of Medicine,University of Sao Paulo,Sao Paulo,Sao Paulo,Brazil,5. Faculty of Medicine,University of Sao Paulo,Sao PAulo,Sao Paulo,Brazil The COVID-19 pandemic has profoundly impacted older adult's health and well-being worldwide. We explored the impact of the COVID-19 pandemic on daily activities and mental health and its relationship with cognitive performance in older adults.
Methods: One-hundred individuals 60 years and older, without cognitive impairment and enrolled in the Brazilian Memory Study (BRAMS), a longitudinal study, were applied the UCLA Loneliness Scale, Perceived Stress Scale (PSS), Geriatric Depression Scale (GDS), and Mini-Mental State Examination (MMSE). Participants were asked whether they had changes in daily routine and social connectedness during the pandemic.
Results: Almost half of the participants (48.4%) reported that the COVID-19 pandemic significantly affected their lives, 38.9% lost a relative or friend because of COVID-19, and 60% had daily routine changes. Relationships (40.5%) and emotion (22%) were reported as the most impacted area. Stopping physical activities and stay at home represented the main routine changed for 78% of participants. The use of voice messages through mobile phones to maintain social connectedness increased from 24.2% to 42.1%. For 38% of participants, their autonomy to daily decisions decreased, and 40% complained that memory got worse during the pandemic. More than 30% felt more stress, loneliness, or depression than in the pre-pandemic period. Controlling for age, sex, and education, higher loneliness scores were significantly associated with low MMES scores (p = 0.018).
Conclusion: Significant changes in life, daily routine, social connectedness, and mental health-related to the COVID-19 pandemic were reported by older adult participants. Loneliness was associated with lower cognitive performance. Severe socioeconomic disadvantage in neighborhoods where nursing homes (NH) are located may be an important contributor to disparities in resident quality of care. Disadvantaged neighborhoods may have undesirable attributes (e.g., poor public transit) that make it challenging to recruit and retain qualified staff. Lower NH staffing could subsequently leave residents vulnerable to adverse events. Thus, the purpose of this study was to evaluate whether NHs located in socioeconomically disadvantaged neighborhoods had lower healthcare provider staffing levels. We linked publicly available NH data geocoded at the Census block-group level with the Area Deprivation Index, a measure of neighborhood socioeconomic factors including poverty, employment, and housing quality (percentiles: 1-100). Consistent with prior literature on threshold effects of neighborhood poverty on outcomes, we characterized NHs as being located in a disadvantaged neighborhood if the census-block group ADI score was ≥85/100. We used generalized estimating equations clustered at the county level with fixed effects for state and rural location to evaluate relationships between ADI score and staffing. NHs located in socioeconomically disadvantaged neighborhoods had 12.1% lower levels of staffing for registered nurses (mean: 5.8 fewer hours/100 resident-days, 95% CI: 4.4-7.1 hours), 1.2% lower for certified nursing assistants (2.9 fewer hours/100 resident days; 95% CI 0.6-5.1 hours), 20% lower for physical therapists (1.4 fewer hours/100 resident-days; 95% CI 1.1-1.8 hours), and 19% lower for occupational therapists (1.3 fewer hours/100 resident-days; 95% CI 1.0-1.6 hours). These findings highlight disparities that could be targeted with policy interventions focused on recruiting and retaining staff in socioeconomically disadvantaged neighborhoods.

INFECTION CONTROL IN SMALL RESIDENTIAL CARE SETTINGS: INSIGHTS FROM A NATIONAL SURVEY AND WASHINGTON STATE DATA Carolyn Ham, and Anna Unutzer, Washington State Department of Health, Shoreline, Washington, United States
Infection control is a vital issue in long-term care, and the increasing popularity of small residential care facilities (SRCF) raises questions about the effectiveness of this model for preventing facility-acquired infections. In SRCF, care is provided in a residential home to a small number of residents. The setting lacks common terminology, and states license SRCF under various titles including Adult Family Homes, Adult Foster Homes and Family Care Homes. To better inform infection control efforts in this unique setting type, DOH staff conducted a comprehensive search to locate states that license SRCF. A total of 24 states were identified and approached to participate in a qualitative research study; 21 responded, three declined and nine were unable to participate due to staff time constraints. Between March 12th and April 15th, 2021, ten public health and regulatory staff from nine states completed semi-structured telephonic interviews on infection control in SRCF. Infection control licensing requirements and public health oversight for SRCF varied significantly across participating states. Data from these interviews was analyzed and compared with two Washington State Adult Family Home (AFH) sources: 1) online survey of AFH providers 2) Infection Control Assessment and Response evaluations conducted by public health staff. Four themes were identified in all three data sets: access to personal protective equipment, environmental safety, staffing issues and knowledge deficits. SRCF are valued by states that license them. Despite the challenges of implementing infection control in the home-like environment, extraordinary opportunities exist for improving care and preventing infections in this setting.

INFLUENCES OF PREJUDICE AND STEREOTYPING IN THE DIRECT CARE WORKFORCE Jennifer May, Duke University, Gaston, North Carolina, United States
Direct Care Workers (DCW; nursing assistants, personal care aides, home health aides) have the most one on one care with sexual and gender minority (SGM) older adults who reside in residential care facilities or use home health services. DCWs make up a vast majority of the healthcare workforce, holding almost five million jobs in 2019, with approximately 70% of the positions held being in residential care facilities. In a qualitative design study, 11 DCWs were interviewed using an open-ended, semi-structured format to describe their perceptions of care provided to SGM older adults in residential care facilities and the home health setting. These results were part of a larger qualitative study which found there were cues of stereotyping and prejudice in DCW narratives toward SGM older adults. The category DCWs' care and social system referred to characteristics of the DCWs' work environment and the perspectives, attitudes, and reported care toward SGM older adults and diverse populations. It was determined that there are synergies among SGM older adults' care and DCW along with DCW workforce issues (short staffed, low wages, lack of health benefits) that may prevent the DCW from being accepting of implicit bias training or culture change within these facilities/agencies. Implications for practice, policy, and future research are discussed.

INSIGHT INTO THE FEASIBILITY AND ACCEPTABILITY OF A MULTI-LIFESTYLE DEMENTIA RISK INTERVENTION
Laura Dodds, and Joyce Siette, Macquarie University, Macquarie Park, New South Wales, Australia Lifestyle interventions based on behaviour change principles may provide a useful mechanism in reducing dementia risk amongst older adults, however intervention acceptability remains relatively unexplored. We assessed the feasibility and acceptability of BRAIN BOOTCAMP, an Australian initiative aiming to improve dementia literary and reduce dementia risk by delivering a brain health box addressing multiple lifestyle factors through education, physical prompts and an individualised brain health profile. Semi-structured phone interviews were conducted with participants (N=94) at completion of the program (3-months) using a theoretical sampling approach to select a range of participants with varying brain health scores, age, gender, education and locality. Interview topics included participants' overall experience and suggestions for program improvement. Interviews were transcribed and analysed using